From Hippocrates to From Hippocrates to Osler to FOAMOsler to FOAM

From Hippocrates to From Hippocrates to Osler to FOAMOsler to FOAM

Joe Lex, MD, FACEP, MAAEMJoe Lex, MD, FACEP, MAAEMDepartment of Emergency MedicineDepartment of Emergency Medicine

Temple University School of MedicineTemple University School of Medicine

Philadelphia, PA USAPhiladelphia, PA USA

joe@joelex.net @JoeLex5joe@joelex.net @JoeLex5

Joe Lex, MD, FACEP, MAAEMJoe Lex, MD, FACEP, MAAEMDepartment of Emergency MedicineDepartment of Emergency Medicine

Temple University School of MedicineTemple University School of Medicine

Philadelphia, PA USAPhiladelphia, PA USA

joe@joelex.net @JoeLex5joe@joelex.net @JoeLex5

No Commercial No Commercial Interests to DeclareInterests to Declare

No Commercial No Commercial Interests to DeclareInterests to Declare

460 – 370 BC460 – 370 BC460 – 370 BC460 – 370 BC

HippocratesHippocratesHippocratesHippocrates

• Trained at the asklepieion of KosTrained at the asklepieion of Kos

• Took lessons from Thracian physician Took lessons from Thracian physician Herodicus of SelymbriaHerodicus of Selymbria

• In In PhaedrusPhaedrus, Plato says “Hippocrates , Plato says “Hippocrates the Asclepiad” thought that a the Asclepiad” thought that a complete knowledge of the nature of complete knowledge of the nature of the body was necessary for medicinethe body was necessary for medicine

• Trained at the asklepieion of KosTrained at the asklepieion of Kos

• Took lessons from Thracian physician Took lessons from Thracian physician Herodicus of SelymbriaHerodicus of Selymbria

• In In PhaedrusPhaedrus, Plato says “Hippocrates , Plato says “Hippocrates the Asclepiad” thought that a the Asclepiad” thought that a complete knowledge of the nature of complete knowledge of the nature of the body was necessary for medicinethe body was necessary for medicine

Hippocratic OathHippocratic OathHippocratic OathHippocratic Oath

To hold him who has taught me this art To hold him who has taught me this art as equal to my parents and to live my as equal to my parents and to live my life in partnership with him …and to life in partnership with him …and to regard his offspring as equal to my regard his offspring as equal to my

brothers … and to brothers … and to teach them this artteach them this art – if they desire to learn it – – if they desire to learn it – without fee without fee

and covenant…and covenant…

To hold him who has taught me this art To hold him who has taught me this art as equal to my parents and to live my as equal to my parents and to live my life in partnership with him …and to life in partnership with him …and to regard his offspring as equal to my regard his offspring as equal to my

brothers … and to brothers … and to teach them this artteach them this art – if they desire to learn it – – if they desire to learn it – without fee without fee

and covenant…and covenant…

980? – 1037980? – 1037980? – 1037980? – 1037

Abū ‘Alī al-Abū ‘Alī al-Ḥusayn ibn Ḥusayn ibn ‘Abd Allāh ‘Abd Allāh ibn Sīnā – ibn Sīnā – AKA AKA پور پور, , سيناسينا

AvicennaAvicenna

-Abū ‘Alī al-Abū ‘Alī al Ḥusayn ibn Ḥusayn ibn Abd Allāh‘ Abd Allāh‘ – ibn Sīnā – ibn Sīnā

AKA AKA پور پور , ,سيناسينا

AvicennaAvicenna

AvicennaAvicennaAvicennaAvicenna

• Most famous Persian physicianMost famous Persian physician

• Also wrote on philosophy, astronomy, Also wrote on philosophy, astronomy, alchemy, geology, psychology, logic, alchemy, geology, psychology, logic, Islamic theology, mathematics, and Islamic theology, mathematics, and physicsphysics

• And he wrote poetryAnd he wrote poetry

• Sort of like Leonardo de VinciSort of like Leonardo de Vinci

• Most famous Persian physicianMost famous Persian physician

• Also wrote on philosophy, astronomy, Also wrote on philosophy, astronomy, alchemy, geology, psychology, logic, alchemy, geology, psychology, logic, Islamic theology, mathematics, and Islamic theology, mathematics, and physicsphysics

• And he wrote poetryAnd he wrote poetry

• Sort of like Leonardo de VinciSort of like Leonardo de Vinci

Avicenna on EducationAvicenna on EducationAvicenna on EducationAvicenna on Education

• Education must prepare someone for Education must prepare someone for a profession whereby he can a profession whereby he can contribute to the social structurecontribute to the social structure

• Society is built entirely on cooperation Society is built entirely on cooperation and specialization of each individualand specialization of each individual

• In other words, get along with your In other words, get along with your consultantsconsultants

• Education must prepare someone for Education must prepare someone for a profession whereby he can a profession whereby he can contribute to the social structurecontribute to the social structure

• Society is built entirely on cooperation Society is built entirely on cooperation and specialization of each individualand specialization of each individual

• In other words, get along with your In other words, get along with your consultantsconsultants

Avicenna on EducationAvicenna on EducationAvicenna on EducationAvicenna on Education

If the teacher transmits If the teacher transmits knowledge with care and knowledge with care and

feeling, then the student will feeling, then the student will copy his manners and his copy his manners and his

virtues, effortlessly and without virtues, effortlessly and without realizing it, in the process of realizing it, in the process of

“learning by imitation”“learning by imitation”

If the teacher transmits If the teacher transmits knowledge with care and knowledge with care and

feeling, then the student will feeling, then the student will copy his manners and his copy his manners and his

virtues, effortlessly and without virtues, effortlessly and without realizing it, in the process of realizing it, in the process of

“learning by imitation”“learning by imitation”

Edgar A. Guest in 1920sEdgar A. Guest in 1920sEdgar A. Guest in 1920sEdgar A. Guest in 1920s

And the lecture you deliver may be very And the lecture you deliver may be very wise and true,wise and true,

But I’d rather get my lessons by But I’d rather get my lessons by observing what you do;observing what you do;

For I might misunderstand you and the For I might misunderstand you and the high advice you give,high advice you give,

But there’s no misunderstanding how But there’s no misunderstanding how you act and how you live.you act and how you live.

And the lecture you deliver may be very And the lecture you deliver may be very wise and true,wise and true,

But I’d rather get my lessons by But I’d rather get my lessons by observing what you do;observing what you do;

For I might misunderstand you and the For I might misunderstand you and the high advice you give,high advice you give,

But there’s no misunderstanding how But there’s no misunderstanding how you act and how you live.you act and how you live.

1493 – 1541 1493 – 1541 1493 – 1541 1493 – 1541

ParacelsusParacelsusParacelsusParacelsus

• Theophrastus Theophrastus Phillippus Aureolus Phillippus Aureolus Bombastus von Bombastus von HohenheimHohenheim

• Contemporary of Contemporary of Martin Luther, Martin Luther, Copernicus, da Copernicus, da VinciVinci

• Theophrastus Theophrastus Phillippus Aureolus Phillippus Aureolus Bombastus von Bombastus von HohenheimHohenheim

• Contemporary of Contemporary of Martin Luther, Martin Luther, Copernicus, da Copernicus, da VinciVinci

ParacelsusParacelsusParacelsusParacelsus

““No man becomes master while No man becomes master while he stays at home, nor finds a he stays at home, nor finds a

teacher behind the stove. teacher behind the stove. Diseases wander here and Diseases wander here and

there the whole length of the there the whole length of the world. He who would world. He who would

understand them must wander.”understand them must wander.”

““No man becomes master while No man becomes master while he stays at home, nor finds a he stays at home, nor finds a

teacher behind the stove. teacher behind the stove. Diseases wander here and Diseases wander here and

there the whole length of the there the whole length of the world. He who would world. He who would

understand them must wander.”understand them must wander.”

ParacelsusParacelsusParacelsusParacelsus

““He stands like a tree with spreading He stands like a tree with spreading branches, and with each year that branches, and with each year that passes the leaves he puts forth seem passes the leaves he puts forth seem richer and greener. Always and richer and greener. Always and everywhere living and active in his everywhere living and active in his power to fructify our souls, he is still power to fructify our souls, he is still living among us today.”living among us today.”

- Jolande Szekacs Jacobi- Jolande Szekacs Jacobi

““He stands like a tree with spreading He stands like a tree with spreading branches, and with each year that branches, and with each year that passes the leaves he puts forth seem passes the leaves he puts forth seem richer and greener. Always and richer and greener. Always and everywhere living and active in his everywhere living and active in his power to fructify our souls, he is still power to fructify our souls, he is still living among us today.”living among us today.”

- Jolande Szekacs Jacobi- Jolande Szekacs Jacobi

1514 – 15641514 – 15641514 – 15641514 – 1564

Andreas VesaliusAndreas VesaliusAndreas VesaliusAndreas Vesalius

31 Dec 1514 – 15 Oct 156431 Dec 1514 – 15 Oct 156431 Dec 1514 – 15 Oct 156431 Dec 1514 – 15 Oct 1564

Andreas VesaliusAndreas VesaliusAndreas VesaliusAndreas Vesalius

• Customary anatomy teaching: sit in Customary anatomy teaching: sit in an elevated chair, read from a text of an elevated chair, read from a text of Galen and watch while an unskilled Galen and watch while an unskilled barber-surgeon conducted the barber-surgeon conducted the dissectiondissection

• Vesalius descended from the chair, Vesalius descended from the chair, handled body, dissected organshandled body, dissected organs

• Customary anatomy teaching: sit in Customary anatomy teaching: sit in an elevated chair, read from a text of an elevated chair, read from a text of Galen and watch while an unskilled Galen and watch while an unskilled barber-surgeon conducted the barber-surgeon conducted the dissectiondissection

• Vesalius descended from the chair, Vesalius descended from the chair, handled body, dissected organshandled body, dissected organs

1668 – 17381668 – 1738 1668 – 17381668 – 1738

Baron Jan Gerrit van Baron Jan Gerrit van Wassenaer heer van Wassenaer heer van Rosenberg, Prefect Rosenberg, Prefect of Rhineland and of Rhineland and

Grand Admiral of the Grand Admiral of the Dutch FleetDutch Fleet

Baron Jan Gerrit van Baron Jan Gerrit van Wassenaer heer van Wassenaer heer van Rosenberg, Prefect Rosenberg, Prefect of Rhineland and of Rhineland and

Grand Admiral of the Grand Admiral of the Dutch FleetDutch Fleet

Baron Jan Gerrit van WassenaerBaron Jan Gerrit van WassenaerBaron Jan Gerrit van WassenaerBaron Jan Gerrit van Wassenaer

Herman BoerhaaveHerman BoerhaaveHerman BoerhaaveHerman Boerhaave

• Dutch botanist, humanist, physician Dutch botanist, humanist, physician 

• Founder of clinical teaching and of Founder of clinical teaching and of modern academic hospitalmodern academic hospital

• Demonstrated relation of symptoms Demonstrated relation of symptoms to lesionsto lesions

• His motto: His motto: Simplex sigillum veri Simplex sigillum veri (Simplicity is the sign of truth.)(Simplicity is the sign of truth.)

• Dutch botanist, humanist, physician Dutch botanist, humanist, physician 

• Founder of clinical teaching and of Founder of clinical teaching and of modern academic hospitalmodern academic hospital

• Demonstrated relation of symptoms Demonstrated relation of symptoms to lesionsto lesions

• His motto: His motto: Simplex sigillum veri Simplex sigillum veri (Simplicity is the sign of truth.)(Simplicity is the sign of truth.)

Occam’s RazorOccam’s RazorOccam’s RazorOccam’s Razor

• Entia non sunt multiplicanda praeter Entia non sunt multiplicanda praeter necessitatemnecessitatem

• Lex parsimoniae: aLex parsimoniae: among competing mong competing hypotheses, the one that makes the hypotheses, the one that makes the fewest assumptions should be fewest assumptions should be selectedselected

• Entia non sunt multiplicanda praeter Entia non sunt multiplicanda praeter necessitatemnecessitatem

• Lex parsimoniae: aLex parsimoniae: among competing mong competing hypotheses, the one that makes the hypotheses, the one that makes the fewest assumptions should be fewest assumptions should be selectedselected

1825 – 1893 1825 – 1893 1825 – 1893 1825 – 1893

CharcotCharcotCharcotCharcot

Replaced Replaced traditional traditional hospital rounds hospital rounds at Salpêtrière at Salpêtrière with clinical with clinical demonstrations demonstrations and patient and patient interviews in interviews in the hospital…the hospital…

Replaced Replaced traditional traditional hospital rounds hospital rounds at Salpêtrière at Salpêtrière with clinical with clinical demonstrations demonstrations and patient and patient interviews in interviews in the hospital…the hospital…

CharcotCharcotCharcotCharcot

……complete complete with curtains, with curtains, lighting, etc…lighting, etc…

……and he and he opened them opened them to the public.to the public.

……complete complete with curtains, with curtains, lighting, etc…lighting, etc…

……and he and he opened them opened them to the public.to the public.

Jean-Martin CharcotJean-Martin CharcotJean-Martin CharcotJean-Martin Charcot

• By the way, that’s By the way, that’s Joseph Babinski Joseph Babinski supporting the supporting the patientpatient

• Other students: Other students: Sigmund Freud, Sigmund Freud, Gilles de la TouretteGilles de la Tourette

• By the way, that’s By the way, that’s Joseph Babinski Joseph Babinski supporting the supporting the patientpatient

• Other students: Other students: Sigmund Freud, Sigmund Freud, Gilles de la TouretteGilles de la Tourette

1849 – 1919 1849 – 1919 1849 – 1919 1849 – 1919

Osler on TeachingOsler on TeachingOsler on TeachingOsler on Teaching

““Observe, record, tabulate, Observe, record, tabulate, communicate. Use your five communicate. Use your five

senses. Learn to see, learn to senses. Learn to see, learn to hear, learn to feel, learn to hear, learn to feel, learn to

smell, and know that by smell, and know that by practice alone you can practice alone you can

become expert.”become expert.”

““Observe, record, tabulate, Observe, record, tabulate, communicate. Use your five communicate. Use your five

senses. Learn to see, learn to senses. Learn to see, learn to hear, learn to feel, learn to hear, learn to feel, learn to

smell, and know that by smell, and know that by practice alone you can practice alone you can

become expert.”become expert.”

Osler on TeachingOsler on TeachingOsler on TeachingOsler on Teaching

““I desire no other epitaph…than I desire no other epitaph…than the statement that I taught the statement that I taught

medical students in the wards, medical students in the wards, as I regard this as by far the as I regard this as by far the

most useful and important work most useful and important work I have been called upon to do.”I have been called upon to do.”

““I desire no other epitaph…than I desire no other epitaph…than the statement that I taught the statement that I taught

medical students in the wards, medical students in the wards, as I regard this as by far the as I regard this as by far the

most useful and important work most useful and important work I have been called upon to do.”I have been called upon to do.”

Osler on TeachingOsler on TeachingOsler on TeachingOsler on Teaching

““No bubble is so No bubble is so iridescent or floats longer iridescent or floats longer

than that blown by the than that blown by the successful teacher.”successful teacher.”

““No bubble is so No bubble is so iridescent or floats longer iridescent or floats longer

than that blown by the than that blown by the successful teacher.”successful teacher.”

1982 – 1986 1982 – 1986 1982 – 1986 1982 – 1986

UTHSC @ San AntonioUTHSC @ San AntonioUTHSC @ San AntonioUTHSC @ San Antonio

UTHSC @ San AntonioUTHSC @ San AntonioUTHSC @ San AntonioUTHSC @ San Antonio

I was 34 years old…I was 34 years old…

……without a college degreewithout a college degree

……but with 4 years as an Army medicbut with 4 years as an Army medic

……and 4 years as an ER techand 4 years as an ER tech

……and 3 years as an ER nurseand 3 years as an ER nurse

……and they took a chanceand they took a chance

But Why FOAM?But Why FOAM?

I was 34 years old…I was 34 years old…

……without a college degreewithout a college degree

……but with 4 years as an Army medicbut with 4 years as an Army medic

……and 4 years as an ER techand 4 years as an ER tech

……and 3 years as an ER nurseand 3 years as an ER nurse

……and they took a chanceand they took a chance

But Why FOAM?But Why FOAM?

UTHSC @ San AntonioUTHSC @ San AntonioUTHSC @ San AntonioUTHSC @ San Antonio

My tuition for the first two years was…My tuition for the first two years was…

USD$300 / yearUSD$300 / yearIt went up to $1200 / year It went up to $1200 / year by the time I graduatedby the time I graduated

My tuition for the first two years was…My tuition for the first two years was…

USD$300 / yearUSD$300 / yearIt went up to $1200 / year It went up to $1200 / year by the time I graduatedby the time I graduated

2000 – present2000 – present2000 – present2000 – present

American Academy of American Academy of Emergency MedicineEmergency MedicineAmerican Academy of American Academy of Emergency MedicineEmergency Medicine

American Academy of American Academy of Emergency MedicineEmergency MedicineAmerican Academy of American Academy of Emergency MedicineEmergency Medicine

• ~5000 members~5000 members

• Membership USD$425 / yearMembership USD$425 / year

• Annual Scientific Assembly: FREE to Annual Scientific Assembly: FREE to membersmembers

• ~5000 members~5000 members

• Membership USD$425 / yearMembership USD$425 / year

• Annual Scientific Assembly: FREE to Annual Scientific Assembly: FREE to membersmembers

2010 – present2010 – present2010 – present2010 – present

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